急诊经皮冠状动脉介入治疗患者早期应用替罗非班的疗效及安全性

Effect and safety of early initiation of tirofiban in patients undergoing primary percutaneous coronary intervention

目的探讨急诊经皮冠状动脉介入治疗（PCI）患者在应用负荷剂量氯吡格雷、阿司匹林的基础上早期应用替罗非班的疗效及安全性。方法选取急性ST段抬高型心肌梗死（STEMI）拟行急诊PCI的患者67例，根据替罗非班给药时间随机分为早期组（救护车上或一进入急诊室即开始给予替罗非班）37例，晚期组（冠脉造影结束后给予替罗非班）30例。应用TIMI血流、校正的TIMI血流帧数（CTFC）、血清肌酸激酶同工酶（CK—MB）峰值时间、ST段回落评价PCI术后梗死血管血流及心肌再灌注疗效，并记录使用替罗非班治疗期间的出血并发症和血小板减少症的发生率。结果两组术后TIMI血流差异无统计学意义（P〉0．05），心肌再灌注早期组优于晚期组（P〈0．05）。使用替罗非班期间，两组均有轻微出血，出血发生率差异无统计学意义（P〉0．05）。结论急诊PCI术前早期给予替罗非班能改善心肌再灌注，减少慢血流的发生。

Objective To assess effect and safety of early initiation of tirofiban on basis of aspirin, hep-arin, and load dosage clopidogrel in patients undergoing primary percutaneous coronary intervention. Methods Sixty seven patients with ST-segment elevated myocardial infarction （STEMI） undergoing primary PCI were en-rolled, and randomized to two groups： early group （n=37, with early administration of tirofiban in ambulance or immediately in emergency department） and late group （n=30, with administration of tirofiban after coronary an- giography）. TIMI flow, corrected TIMI frame count （CTFC）, serum creatine phosphokinase isoenzyme MB （CK-MB ） peak time, and ST segment resolution were implemented to evaluate myocardial reperfusion and infarction re-lated artery （IRA） patency after PCI. The incidences of bleeding complications and thrombocytopenia during ad-ministration of tirofiban were registered to assess the safety. Results Similar TIMI flow after PCI appeared in both groups （P〉0.05）, and better myocardial reperfusion （P〈0.05） were observed in early group, also same slight bleeding complications and similar incidences of bleeding were shown in both groups during administration of tirofiban（P〉0.05 ）. Conclusion Early administration of tirofiban before primary PCI improves myocardial reperfu-sion and reduces occurrence of slow-flow in patients undergoing primary PCI.